Malignancies Arising in Allograft Kidneys
Rola Saleeb, Hala Faragalla, Keiyan Sy, George M Yousef, Robert Stewart, Catherine J Streutker. University of Toronto, Toronto, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada
Background: Cancer in the post kidney transplant population has been a rising concern in many publications, causing a debate regarding the need for increased post transplant surveillance. Renal carcinoma is one of the most common cancers to occur in the transplant population, almost always arising in diseased native kidneys. Rarely, tumors arise in the transplanted kidney. Our case series reports four cases of malignancy in allograft kidneys.
Design: The renal transplantation data base at St. Michael's Hospital, Toronto, Canada, containing 1584 patients, was reviewed for diagnoses of malignancies arising in the post transplant period. Cases of tumors arising in the allograft were identified, and the reports and pathology slides were reviewed.
Results: Four cases of malignancies arising in the allograft kidney were identified in the transplant population; this is a significant proportion (3.9%) of the total post-transplant malignancies (101 malignancies in 1584 patients). One tumor was a high grade urothelial carcinoma in the pelvis of the donor kidney 9 years post transplant and 6 years post BK virus infection. The other 3 cases were renal cell carcinomas, developing 1 year, 9 years, and 16 years post-transplant. The first was a clear cell carcinoma, Fuhrman Grade 3, pT1a, the second a renal cell carcinoma with areas of both clear cell and papillary architecture, Fuhrman Grade 3, pT1b and the third was a pure papillary renal cell carcinoma, Fuhrman Grade 1, pT1a. Tissue from the four tumors was submitted for DNA testing which showed that samples from all 4 tumours had two distinct profiles, suggestive of donor origin with infiltration by recipient lymphocytes.
Conclusions: Previous reports suggest that malignancies in allograft kidneys (other than post transplant lymphoproliferative disorders) were rare. We identified 4 tumours, three renal cell carcinomas and one urothelial carcinoma, in 1584 transplant patients. Tumors developed 1-16 years after transplantation. One patient had prior BK virus infection: there is a correlation in previous literature between BK virus infection and urothelial carcinoma. While the rate of malignancy in allograft kidneys is small, screening of the donor kidneys by ultrasound and/or urine cytology may be of use in detecting these lesions.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 82, Wednesday Morning